Care Plan 11:   Probable Discogenic Involvement
With Firm Neurologic Signs

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

ETIOLOGY: Space occupying disc herniation is likely. Firm neurologic signs have potential for development of permanent residuals, and such cases may be surgical candidates. In the presence of firm neurologic signs such as significant motor weakness, muscle atrophy, severe intractable pain, and documented nerve damage, a conservative regimen is likely to have already failed. Under such circumstances, a short trial of manipulation may be warranted if not previously attempted and pain is manageable. If progressive deterioration occurs, prolonged manipulative management is not considered.

APPROPRIATE CARE: Myofascial soft tissue work, flexion distraction or McKenzie therapeutic exercises along with spinal adjusting, with a prescription for a home regimen of exercises, will reduce spasm and increase ROM.

EXPECTED FREQUENCY AND DURATION OF CARE: Depending on the degree of annular bulging and the nature of neurologic damage, healing requires a greater amount of time than non-disc and lesser disc injuries. This condition is treated in similar fashion to disc conditions with soft neurologic findings; However, response is typically slowed and team management should be considered. Care is usually of several months duration, with initial frequency at 3 or more sessions per week, gradually reducing to PRN frequencies of 1 per month to discharge.

TOTAL: 26-32 sessions over 6-8 months.

WEEK	CARE	PROGRESS	M	T	W	T	F	S
1	Palliative measures (Typically medical pharmaceutical management) Myofascial work	Gradual relief of muscle spasm and some pain reduction 3-5 /week	X		X		X
2-4	Myofascial work Adjusting/ flexion distraction McKenzie exercises Home exercise	>50% subjective pain relief >50% improved ROM Decrease in pain distribution 2-3 /week		X		X
5-16	Adjusting (SMT) Myofascial work Home strengthening exercise	Gradual progressive improvement with resolution PRN follow-ups 1-2 / week			X

PRN = per required need (patient request)

SMT = spinal manipulative therapy (adjusting)

ATTENUATING FACTORS: The nature of the symptoms, the degree of the initial disc injury, general metabolic health and compliance with home exercise plan all contribute to recovery time.

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